Abstract
Objective: We are in this study, the high-and low-flow anesthesia, hemodynamics, recovery, and we aimed to compare in terms of cost. Methods: Submucosal resection and septorhinoplasty operation is planned in the study group, ASA I-II, the operation will last for 1–3 hours, between 18–65 years of age, 40 patients were included. Group D low-flow, high-flow group was determined as the Y group. Hemodynamic changes was measured preop. In Group D of the 10th from the current 1 min after L / min (0.5L/dk oxygen, 0,5 L/min air) downloads. Study, FIDES, ETDES, FiO2, FiCO2, ETO2, ETCO2, MAK measurement after intubation, 10, 15, 30, 45, 60, 75 minutes was measured. Group D, high-flow anesthesia is terminated 10 minutes before reanesthetized 6 L/min was started. Results: Intra-operative group D in 15 minutes mean blood pressure was statistically lower. FiO2, Group D in the fresh gas flow 1 L/min or after deduction of up to 35% of the fallen, but never below the 30% critical value. ETDES 30 min, MAK, and FIDES 15 and 30 min in group A to group D also found relatively low. Oxygen and desflurane consumption was significantly lower in group D according to the group H. Desflurane consumption falls by 66%, according to group D than in Group A was lower.Conclusion: We observed that low-flow anesthesia is more cost-effective than high-flow anesthesia and it’s as safe as high-flow anesthesia on hemodynamics and recovery time
Keywords
References
- Baum J. Low-flow anaesthesia: Theory, practice, technical preconditions, advantages, and foreign gas accumulation. Journal of Anaesthesia 1999;13(3):166-74.
- Vecil M, Di Stefano C, Zorzi F. Low flow, minimal flow and closed circuit system inhalational anesthesia in modern clinical practice. SignaVitae 2008;3 (suppl 1):33–6.
- Baxter AD. Low and minimal flow inhalational anaesthesia. Can J Anaesth 1997;44(6):643-52.
- Baum J. Low flow anesthesia Anaesthesist 1994;43(3):194–210.
- Patel SS, Goa KL. Desflurane. A review of its pharmacodynamic and pharmacokinetic properties and its efficacy in general anaesthesia. Drugs 1995;50(4):742–67.
- Johansonn A, Lundberg D, Luttropp HH, et al. Low-flow anaesthesia with desflurane: Kinetics during clinical procedures. Eur J Anaesth. 2001;18(8):499-504.
- Baum J, Stanke HG. Low Flow-und Minimal Flow-Anästhesie mit Sevofluran. Anaesthesist 1998;[Suppl 1] 47:70–6.
- Nathanson MH, Fredman B, Smith I, et al. Sevoflurane versus desflurane for outpatient anaesthesia: a comparison of maintenance and recovery profiles. A & A 1995;81(6):1186–90.
- Hargasser SH, Mielke LL, Entholzner EK. Experiences with the new inhalational agents in low-flow anaesthesia and closed-circuit technique. Monitoring and technical equipment. Appl Cardiopulm Pathophysiol. 1995;5 (Suppl 2):47–57.
- Hargasser S, Hipp R, Breinbauer B. A lower solubility recommends the use of desflurane more than isoflurane, halothane, and enflurane under low-flow conditions. J Clin Anesth 1995;7(1):49–53.
- Saraiva RA. Desflurane: Physicochemical Properties, Pharmacology and Clinic Use. Rev Bras Anestesiol 2003;53(2):214–26.
- Eger EI II. Desflurane animal and human pharmacology: aspects of kinetics, safety, and MAC. Anesth Analg 1992;75:4(Suppl): 3–9.
- Baum J, Berghoff M, Stanke HG, et al. Low-flow anesthesia with desflurane. Anaesthesist 1997;46(4):287– 93.
- Toğal T, Ayas A, Demirbilek S ve ark. Düşük Akımlı Anestezide İzofluran ve Desfluran İle Vücut Ağırlığına Göre Uygulanan Taze Gaz Akımlarının Karşılaştırılması. Türk Anest Rean Der Dergisi. 2004;32(2):91–9.
- Weiskopf RB, Cahalan MK, Eger EI, et al. Cardiovascular actions of desflurane in normocarbic volunteers. Anesth Analg 1991;73(2):143–56.
- Lee DJH, Robinson DL, Soni N. Efficiency of a circle system for short surgical cases: comparision of desflurane with isoflurane. BJ Anaesth 1996;76(6):780-2.
- Baum JA. Clinical applications of low flow and closed circuit anaesthesia. Acta Anaesthesiol Belg 1990;41(3):239-47.
- Hendrickx JFA, Cooman DS, Vandeput DM, et al. Air-oxygen mixtures in circle systems. Journal of Clinical Anaesthesia 2001;13:461–4.
- Baum JA. Düşük Akımlı Anestezi (Çev. Ed. Tomatır E). Klinik uygulamada düşük akımlı anestezi, İstanbul: Nobel Tıp Kitabevi; 2002; 220–68.
- Kızıltepe H. Düşük Akım Anestezisinde Sevofluran ve Desfluranın nefrotoksisitelerinin karşılaştırılması. Uzmanlık Tezi, İstanbul–2006.
- Yıldız K. Laparoskopik kolesistektomilerde düşük akım anestezisinin değerlendirilmesi. Uzmanlık Tezi. İstanbul–2007.
- Kaymak Ç, Başar H, Tekin Ö. Düşük Akım ve Yüksek Akımla Uygulanan Desfluran Anestezisinde Hemodinamik Etkilerin Torasik Elektriksel Biyoempedans Monitorizasyon ile Karşılaştırılması. TARD Dergisi 2007;35(1):29-37.
- Gormley WP, Muyıray JM. Intravenous lidocaine does not atenuate the cardiovasculer and catecholamine response to a rapid increase in desflurane concentration. Anesth Analg 1996;82:358–61.
- Ebert TJ, Muzi M. Sympathetic hyperactivity during desflurane anesthesia in healthy volunteers. A comparison with isoflurane. Anesthesiology 1993;79(3):444–53.
- Bennett JA, Mahadeviah A, Stewart J, et al. Desflurane controls the hemodynamic response to surgical stimulation more than isoflurane. J Clin Anesth 1995;7(4):288-91.
- Aitkenhead AR, Smith G. Inhalation anesthetic agents. Textbook of Anaesthesia 2nd Edition. 1990;160.
- Tarazi EM, Philip BK. A Comparison of recovery after sevoflurane or desflurane in ambulatory anaesthesia. J Clin Anesth 1998;10(4):272–7.
- Dolk A, Cannerfelt R, Anderson RE. Inhalation anaesthesia is cost-effective for ambulatory surgery: a clinical comparison with propofol during elective knee arthroscopy. Eur J Anaesthesiol 2002;19(2):88–92.
- Yıldırım A, Göksu H, Toprak Ç. İzofluran, desfluran ve sevofluran ile uygulanan düşük akımlı anestezinin, anestezi kalitesi ve güvenirliliğinin karşılaştırılması. Fırat Tıp Dergisi 2006;11(3):170–4.
- Rosenberg MK, Bridge P, Brown M. Cost Comparision: A desflurane-versus a propofol-based general anesthetic technique. Anesth Analg 1994;79(5):852–5.
- Coetzee JF, Stewart LJ. Fresh gas flow is not the only determinant of volatile agent consumption: a multi- centre study of low-flow anaesthesia. Br J Anaesth 2002;88(1):46–55.
Yüksek ve Düşük Akımlı Desfluran Anestezisinin Hemodinami, Derlenme ve Maliyet Açısından Karşılaştırılması
Abstract
Amaç: Çalışmada, yüksek ve düşük akımlı desfluran anestezisinin hemodinami, derlenme ve maliyet açısından karşılaştırılması amaçlandı. Yöntem: Çalışmaya submukozal rezeksiyon ve septorinoplasti operasyonu planlanan ASA I-II, 18–65 yaş, 40 hasta dahil edildi. Grup D (düşük), grup Y (yüksek) akımlı grup olarak belirlendi. Grup Y’de anestezi uygulaması 3L/dk oksijen, 3L/dk hava karışımı ile 6 L/dakikadan sağlandı. Grup D’ de ise 10. dk’dan sonra akım 1 L/dakikaya (0.5L/dk oksijen, 0,5 L/dk hava) indirildi. Çalışmada FiDES, ETDES, FiO2, FiCO2, ETO2, ETCO2, MAK entübasyon sonrası 10, 15, 30, 45, 60, 75 dakikalarda ölçüldü. Grup D’de anestezi sonlandırılmadan 10 dk önce yeniden yüksek akımlı anesteziye (6 L/dk) geçildi. Bulgular: İntraoperatif 15 dakikadaki OKB grup D de istatiksel olarak daha düşük bulundu. FİO2, grup D de taze gaz akımı 1 L/dk’ya indirildikten sonra %35’e kadar düşmüş, ancak kritik değer olan %30’un altına hiçbir zaman inmemiştir. ETDES 30 dk, MAK ve FİDES 15 ve 30 dk da grup D de grup Y ye göre düşük bulunmuş. Ancak vaporizatör ayarlarında bir değişiklik ihtiyacı olmadı. Oksijen ve desfluran tüketimi anlamlı olarak grup D de grup Y ye göre düşüktü. Desfluran tüketiminde düşme grup D de Grup Y ye göre %66 oranında daha düşük olarak gerçekleşti. Sonuç: Düşük akımlı anestezinin hemodinami ve derlenme yönünden yüksek akımlı anestezi kadar güvenli olduğu ve maliyeti azalttığı gözlendi
Keywords
References
- Baum J. Low-flow anaesthesia: Theory, practice, technical preconditions, advantages, and foreign gas accumulation. Journal of Anaesthesia 1999;13(3):166-74.
- Vecil M, Di Stefano C, Zorzi F. Low flow, minimal flow and closed circuit system inhalational anesthesia in modern clinical practice. SignaVitae 2008;3 (suppl 1):33–6.
- Baxter AD. Low and minimal flow inhalational anaesthesia. Can J Anaesth 1997;44(6):643-52.
- Baum J. Low flow anesthesia Anaesthesist 1994;43(3):194–210.
- Patel SS, Goa KL. Desflurane. A review of its pharmacodynamic and pharmacokinetic properties and its efficacy in general anaesthesia. Drugs 1995;50(4):742–67.
- Johansonn A, Lundberg D, Luttropp HH, et al. Low-flow anaesthesia with desflurane: Kinetics during clinical procedures. Eur J Anaesth. 2001;18(8):499-504.
- Baum J, Stanke HG. Low Flow-und Minimal Flow-Anästhesie mit Sevofluran. Anaesthesist 1998;[Suppl 1] 47:70–6.
- Nathanson MH, Fredman B, Smith I, et al. Sevoflurane versus desflurane for outpatient anaesthesia: a comparison of maintenance and recovery profiles. A & A 1995;81(6):1186–90.
- Hargasser SH, Mielke LL, Entholzner EK. Experiences with the new inhalational agents in low-flow anaesthesia and closed-circuit technique. Monitoring and technical equipment. Appl Cardiopulm Pathophysiol. 1995;5 (Suppl 2):47–57.
- Hargasser S, Hipp R, Breinbauer B. A lower solubility recommends the use of desflurane more than isoflurane, halothane, and enflurane under low-flow conditions. J Clin Anesth 1995;7(1):49–53.
- Saraiva RA. Desflurane: Physicochemical Properties, Pharmacology and Clinic Use. Rev Bras Anestesiol 2003;53(2):214–26.
- Eger EI II. Desflurane animal and human pharmacology: aspects of kinetics, safety, and MAC. Anesth Analg 1992;75:4(Suppl): 3–9.
- Baum J, Berghoff M, Stanke HG, et al. Low-flow anesthesia with desflurane. Anaesthesist 1997;46(4):287– 93.
- Toğal T, Ayas A, Demirbilek S ve ark. Düşük Akımlı Anestezide İzofluran ve Desfluran İle Vücut Ağırlığına Göre Uygulanan Taze Gaz Akımlarının Karşılaştırılması. Türk Anest Rean Der Dergisi. 2004;32(2):91–9.
- Weiskopf RB, Cahalan MK, Eger EI, et al. Cardiovascular actions of desflurane in normocarbic volunteers. Anesth Analg 1991;73(2):143–56.
- Lee DJH, Robinson DL, Soni N. Efficiency of a circle system for short surgical cases: comparision of desflurane with isoflurane. BJ Anaesth 1996;76(6):780-2.
- Baum JA. Clinical applications of low flow and closed circuit anaesthesia. Acta Anaesthesiol Belg 1990;41(3):239-47.
- Hendrickx JFA, Cooman DS, Vandeput DM, et al. Air-oxygen mixtures in circle systems. Journal of Clinical Anaesthesia 2001;13:461–4.
- Baum JA. Düşük Akımlı Anestezi (Çev. Ed. Tomatır E). Klinik uygulamada düşük akımlı anestezi, İstanbul: Nobel Tıp Kitabevi; 2002; 220–68.
- Kızıltepe H. Düşük Akım Anestezisinde Sevofluran ve Desfluranın nefrotoksisitelerinin karşılaştırılması. Uzmanlık Tezi, İstanbul–2006.
- Yıldız K. Laparoskopik kolesistektomilerde düşük akım anestezisinin değerlendirilmesi. Uzmanlık Tezi. İstanbul–2007.
- Kaymak Ç, Başar H, Tekin Ö. Düşük Akım ve Yüksek Akımla Uygulanan Desfluran Anestezisinde Hemodinamik Etkilerin Torasik Elektriksel Biyoempedans Monitorizasyon ile Karşılaştırılması. TARD Dergisi 2007;35(1):29-37.
- Gormley WP, Muyıray JM. Intravenous lidocaine does not atenuate the cardiovasculer and catecholamine response to a rapid increase in desflurane concentration. Anesth Analg 1996;82:358–61.
- Ebert TJ, Muzi M. Sympathetic hyperactivity during desflurane anesthesia in healthy volunteers. A comparison with isoflurane. Anesthesiology 1993;79(3):444–53.
- Bennett JA, Mahadeviah A, Stewart J, et al. Desflurane controls the hemodynamic response to surgical stimulation more than isoflurane. J Clin Anesth 1995;7(4):288-91.
- Aitkenhead AR, Smith G. Inhalation anesthetic agents. Textbook of Anaesthesia 2nd Edition. 1990;160.
- Tarazi EM, Philip BK. A Comparison of recovery after sevoflurane or desflurane in ambulatory anaesthesia. J Clin Anesth 1998;10(4):272–7.
- Dolk A, Cannerfelt R, Anderson RE. Inhalation anaesthesia is cost-effective for ambulatory surgery: a clinical comparison with propofol during elective knee arthroscopy. Eur J Anaesthesiol 2002;19(2):88–92.
- Yıldırım A, Göksu H, Toprak Ç. İzofluran, desfluran ve sevofluran ile uygulanan düşük akımlı anestezinin, anestezi kalitesi ve güvenirliliğinin karşılaştırılması. Fırat Tıp Dergisi 2006;11(3):170–4.
- Rosenberg MK, Bridge P, Brown M. Cost Comparision: A desflurane-versus a propofol-based general anesthetic technique. Anesth Analg 1994;79(5):852–5.
- Coetzee JF, Stewart LJ. Fresh gas flow is not the only determinant of volatile agent consumption: a multi- centre study of low-flow anaesthesia. Br J Anaesth 2002;88(1):46–55.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Articles |
| Authors | |
| Publication Date | August 1, 2014 |
| Published in Issue | Year 2014 |